Cardiovascular Effects of lyengar Yoga

描述(申请人提供)：高血压影响大约5000万美国人(占总人口的24%)和全球10亿人。高血压是中风、心力衰竭、心肌梗死和肾脏疾病的一个强有力的、一致的和独立的危险因素。今年早些时候，联合国家委员会(JNC7)更新了关于高血压评估和管理的建议。在JNC7的研究结果中，该委员会强调了收缩压(SBP)的重要性，并确定了一类新的高血压前期患者，他们适合进行有效的生活方式治疗，以降低他们的心血管风险。在治疗高血压的生活方式疗法中，到目前为止，大部分研究都是关于饮食(低钠)和运动建议，以及膳食补充剂(大蒜、鱼油)。然而，心身疗法(MBT)，如调解和瑜伽，在控制血压升高方面越来越受欢迎。瑜伽之所以特别有吸引力，是因为它在这个国家的受欢迎程度和接受度正在迅速增长，还因为它的多模式方法结合了姿势(体式)、呼吸(调息)和冥想，是古典治疗性瑜伽的一种特殊形式，它依赖于严格按照脚本编写的体式，可以标准化，并且很容易复制。在这项研究中，我们建议通过一项随机临床试验，在3个特定区域使用增强型常规护理对照组，严格和科学地研究结构化12周Lyengar瑜伽计划(IYP)在高正常到I期高血压患者中的安全性和有效性。1)这项研究的主要终点将是量化IYP对24小时动态血压监测(ABPM)获得的平均日间SBP的影响。2)次要终点将是比较IYP对心率变异性(HRV)的影响，心率变异性是心脏自主神经活动的衡量标准，也是心血管风险的另一个重要替代指标。3)最后，我们将评估IYP对情绪、感知压力和与健康相关的生活质量的生理和心理测量的影响。通过使用血压和心率变异性的黄金标准测量，并与高技能认证的Lyengar瑜伽练习者网络合作，我们将能够估计Lyengar瑜伽对SBP的真实影响，并开始阐明这种影响的机制。这项试验还将为RO1提交生成充足的初步数据，以便将Lyengar瑜伽与其他非运动MBT进行直接比较，例如超验冥想、既定的生活方式建议，如DASH饮食或主动药物控制。

DESCRIPTION (provided by applicant): Hypertension affects approximately 50 million Americans (24% of the population) and 1 billion individuals worldwide. Hypertension is a potent, consistent and independent risk factor for stroke, heart failure, myocardial infarction and kidney disease. Earlier this year, the Joint National Committee (JNC7) updated its recommendation on the evaluation and management of hypertension. Among the findings of JNC7, the committee emphasized the importance of systolic blood pressure (SBP) and identified a new category of prehypertensive patients who are candidates for effective lifestyle therapies to reduce their cardiovascular risk. Among lifestyle therapies for elevated blood pressure, much of the research to date has been on dietary (low sodium) and activity advice, and dietary supplements (garlic, fish oils). However, mind-body therapies (MBT) such as mediation and yoga are gaining popularity in managing elevations in blood pressure. Yoga is particularly attractive since its popularity and acceptability is rapidly growing in this country, as well as because its multimodal approach, combining postures (asanas), breathing (pranayama) and meditation, lyengar yoga is a particular form of classical therapeutic yoga which relies on tightly scripted asanas which can be standardized, and easily replicated. For this study, we propose to rigorously and scientifically investigate the safety and efficacy of a structured 12 week lyengar Yoga program (IYP) in patients with high-normal to stage I hypertension via a randomized clinical trial using an enhanced usual care comparator group on 3 specific areas. 1) The primary endpoint of this study will be to quantify the effect of the IYP on mean daytime SBP obtained from 24 hour ambulatory blood pressure monitoring (ABPM). 2) The secondary endpoint will be to compare the effects of IYP on heart rate variability (HRV), a measure of cardiac autonomic activity and another important surrogate marker of cardiovascular risk. 3) Finally, we will assess the effects of IYP on physiologic and psychological measures of mood, perceived stress and health related quality of life. By using gold-standard measures of blood pressure and HRV, and collaborating with a network of highly skilled certified lyengar yoga practitioners, we will be able to estimate the true effect of lyengar yoga on SBP, and begin to elucidate mechanisms of this effect. This trial will also generate ample preliminary data for RO1 submissions to allow direct comparisons of lyengar yoga against other non-movement MBTs such as transcendental meditation, established lifestyle recommendations such as the DASH diet, or active pharmacologic control.